To Attend

If you wish you may download an application then print and send.

OR, fill out the following application, Please note your sponsor will still need to fill out the Sponsor Application.

Make sure you see that it was successful in green at the bottom of the form after you press submit.  You should receive an email with the information you entered.  If you don’t receive the email, please email webmaster@inkyvdc.org with the pertinent information.
  PilgrimRenewal
Your Name (required)
Address (required)
City (required)
State (required)
Zip (required)
email (required)
phone (required)
Marital Status (required) MarriedDivorcedSingleWidowed
Spouse Name
Spouse Phone
Number of Children


Family Member other than Spouse to contact in case of Emergency:

Name (required)
Phone (required)
Relationship


Your Background

Occupation
Education
Date of Birth
Church Name
Pastor/Priest/Minister's Name
Denomination
Church Address
Church City
Church State
Church Zip


Weekend You Wish To Attend?

Date
Location
  MenWomenCoed
Sponsor's Name (required)
If you don't have a sponsor, enter 'I Need One'.
Sponsor's Phone
Sponsor's email
Name to be used on name tag


Medical Questions

Do you have any special dietary requirements? YESNO
What kind of dietary requirements?

DiabeticVegetarianLow SaltGluten FreeOther:

Do you require medications at specific times each day? YESNO
Do you have any health or physical restrictions that require special equipment or facilities? YESNO

If you answered "YES" to the above medical questions, Please give us some details so that we may assist you on YOUR weekend. If you want someone to call you regarding special needs, please let us know.

  

Please talk to your sponsor regarding the cost of the week-end. If you are paying for the weekend, the cost is $120 (This includes the $20 application fee). You can conveniently use the PayPal 'Donate' on the right edge of this page towards to top to pay. If you can not pay for the week-end please talk it over with your sponsor. Additionally, there are scholarships available, contact the Pre-Weekend Chair for more information.